For the stimulation of the right cardiac cavities, it typically is sufficient to implant an endocardial probe through the right peripheral venous network. On the other hand, to stimulate the left cardiac cavities, the situation is more complex and the solution most often adopted concerns introducing the stimulation probe through the right atrium and then into the coronary network via the ostium of the coronary sinus. This implant technique is, however, not always realizable, in particular when the configuration of the coronary sinus is too sinuous, or in case of thrombosis (blockage).
Another solution, known as the “trans-septal approach,” concerns passing the probe through the interatrial or interventricular wall or “cardiac septum”, to stimulate the left cavity (atrium and/or ventricle), according to the configuration and the placement of the probe. This procedure as it is currently employed presents, however, high operational risks, in particular of accidental perforation of the aorta, and/or of dissection of the walls of the right atrium by an unexpected rotatory movement of the septum piercing needle. In any event, this technique is very delicate to implement and requires a great deal of skill from the surgeon who must, to be able to traverse the septum, carry out multiple punctures of the wall, while always making sure of the correct positioning of the probe, with the crossing of the septum to be undertaken only if there remains no doubt about the position or placement of the needle.
U.S. Pat. No. 5,190,528 describes a kit allowing one to introduce trans-septally a catheter in order to access blood in the left atrial cavity, to recycle it towards the arterial circuit via an extracorporal pump. The penetration of the septum is carried out by a needle extending from the extremity of a catheter, which comes to pierce the interatrial septum. A catheter is then advanced over the needle through the septum and then the needle is withdrawn. The handling of such a device is particularly delicate to avoid improper movement, and must be made by an experienced surgeon under fluoroscopic examination in order to determine the position and the distance of the needle relative to the wall to be perforated.
U.S. Pat. No. 5,312,341 describes an improvement in which the trans-septal catheter is equipped with a retention means, for example, in the form of an inflatable collar, to maintain in place the catheter so that its distal extremity remains inside the left atrium. Although this improves safety after the implantation of the catheter, it does not solve the difficulty of the precise penetration of the septum for the placement of the catheter, with the high risks attached to such an intervention.
The present invention is particularly useful for the placement of a probe in a left cardiac cavity, e.g., to stimulate the left cavity using an “active implantable medical device,” as such devices are defined by the Jun. 20, 1990 directive 90/385/CEE of the Council of the European Communities, and more particularly a device such as a cardiac pacemaker, a defibrillator and/or a cardiovertor and/or a “multisite” device. But it should be understood that the invention is not limited to the placement of stimulation probes. As it will be understood by a person of ordinary skill in the art, the kit also applies advantageously to any invasive surgical technique that requires traversing the cardiac septum, for example, to carry out clinical investigations in one or the other of the left cardiac cavities. It can also be used in an angioplasty procedure, in particular for operations of mitral valvuloplasty.